Freddy Tercero
Fontana,CA
Summary
Overview
13
13
years of professional experience
Work History
Utilization Management Outpatient Coordinator
Inland Empire Health Plan - IEHP
11.2021 - Current
- Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
- Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
- Responsible for meeting accuracy standards for appropriate authorizations of referrals.
- Verifying eligibility and make outreach to provider's offices or members to obtain additional information.
Member Services Representative
Inland Empire Health Plan - IEHP
10.2019 - 11.2021
- Support members with simple questions regarding, Eligibility, portal, pcp change, and ID cards
- Assist members in the best way possible using resources and other alternatives with empathy and focus on a one call resolution
- Supports with questions and internal transfer to BH, transportation, Care Management, Responsible alerts, Interpreter request, Grievances and Appeals, coverage and benefits
Patient Access Emergency Dept.
San Antonio Regional Hospital Emergency Room
12.2017 - 10.2019
- Registering patients, as well verifying all patient information/demographics and insurance details
- Using different sites to obtain insurance eligibility
- Collect co-pays, answer calls and explaining various forms such as patient rights, medical release and insurance, ensuring completion of paperwork
- Preparing and distributing patient identification band
Front Office Supervisor/Medical Records
Healthpointe Medical Group
09.2012 - 12.2017
- Take incoming calls daily, data entry and accurate documentation of those calls
- Provide patients with information including deductibles, co-pays, referrals, eligibility, appointments and treatment authorizations
- Compile and maintain records of business transactions and office activities
- Act as a liaison between Healthpointe, Workers Compensation Insurance Adjusters and Attorneys
- Assistant patients with forms including FMLA and Disability forms
- Copy and maintain medical records according to company protocol with regard to sensitive patient information
Warehouse/Packer
Sterling Staffing
05.2012 - 07.2012
- Assemble, line and pad cartons, containers using various types of hand tools
- Placed products onto a moving conveyer for transport to specified areas for shipping
- Loaded materials and products info package processing equipment
Dental Assistant (Externship)
Colton Dental Group
03.2012 - 04.2012
- To assist providers with procedures including composite restorations, extractions coronal polishing, xrays, root canal treatments and impressions
- Compile and maintain records of business transaction and office activities
- Clean and maintain all exam rooms, maintain tray set ups and chair side assistances
Education
No Degree - Dental Assistant
Four D College
Colton, CA02-2012
High School Diploma -
Rialto High School
Rialto, CA05-2011
Skills
- Medical terminology proficiency
- HIPAA compliance
- Patient care coordination
- Insurance verification
- Critical Thinking
- Bilingual in Spanish
- Attention to detail
Timeline
Utilization Management Outpatient Coordinator
Inland Empire Health Plan - IEHP
11.2021 - Current
Member Services Representative
Inland Empire Health Plan - IEHP
10.2019 - 11.2021
Patient Access Emergency Dept.
San Antonio Regional Hospital Emergency Room
12.2017 - 10.2019
Front Office Supervisor/Medical Records
Healthpointe Medical Group
09.2012 - 12.2017
Warehouse/Packer
Sterling Staffing
05.2012 - 07.2012
Dental Assistant (Externship)
Colton Dental Group
03.2012 - 04.2012
No Degree - Dental Assistant
Four D College
High School Diploma -
Rialto High School
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